Doppler EUS-guided treatment of gastric Dieulafoy's lesion

Abstract

Dieulafoy's vascular malformation is a congenital anomaly in which a large caliber artery resides close to the mucosal surface. 1 Juler GL Labitzke HG Lamb R Allen R. The pathogenesis of Dieulafoy's gastric lesion. Am J Gastroenterol. 1984; 79: 195-200 PubMed Google Scholar During emergency endoscopy, Dieulafoy's lesions may be difficult to visualize because of the torrential arterial bleeding and/or the lack of a substantial mucosal lesion. The sensitivity of an initial endoscopy for detection of these lesions is thought to be only 63%. 2 Norton ID Petersen BT Sorbi DS Balm RK Alexander GL Gostout CJ. Management and long-term prognosis of Dieulafoy's lesion. Gastrointest Endosc. 1999; 50: 762-767 Abstract Full Text Full Text PDF PubMed Scopus (168) Google Scholar Endoscopic treatment is usually successful during the acute event, but rates of recurrent bleeding can be as high as 15%. 3 Reilly HF AI-Kawas FH. Dieulafoy's lesion: diagnosis and management. Dig Dis Sci. 1991; 36: 1702-1707 Crossref PubMed Scopus (125) Google Scholar Several endoscopic modalities are now available to treat Dieulafoy's lesions, such as monopolar or multipolar electrocoagulation, laser photocoagulation, argon plasma coagulation, sclerotherapy, banding, and heater probe coagulation. To date, there is no secure method for assuring that blood flow in the feeding artery has been effectively terminated in response to endoscopic therapy. With the introduction of Doppler EUS and the development of catheter-based US probes, highly detailed imaging of the gut wall layers, mucosal vascular anatomy, and blood flow can be obtained. This is a case of a patient with a gastric Dieulafoy's lesion who had recurrent bleeding 5 months after banding ligation in whom EUS with Doppler US was used to diagnose the lesion and then guide endoscopic therapy.